Last updated on 30th August 2009
The overlap between money and the health professions seems to involve a complex, multi-faceted set of issues. I was triggered into thinking about this by the coincidence of three events. One was a conversation at the recent annual BABCP psychotherapy conference, a second was reading Lewis Hyde's book "The gift", and the third was struggling to pay my most recent tax bill.
The conference conversation was simultaneously refreshingly direct and unpleasantly off-putting. I was chatting to a psychotherapist colleague who works privately outside the NHS. It turned out they charged at nearly three times the hourly rate that I do. When asked about those who couldn't afford their fees, they came out with the memorable line "Other people's difficult lives aren't my concern" - maybe pantomime villain here, but maybe not. They went on to talk about "acting as if you like someone" as a way to cope with rich but difficult clients, and how taking the money at the end of the consultation could dramatically change one's judgement about how much one wanted to do this kind of work. I found myself cringing, but there is of course an argument that health professionals should be paid as much as other professionals like lawyers and accountants. My conference colleague was doing no more than price themself into this kind of league - a level of income that recent pay rises have made available to most medical doctors working in the NHS.
The second event was reading Lewis Hyde's book "The gift: how the creative spirit transforms the world". Hyde discusses how writers, poets and other artists coexist with a society whose values are largely governed by the rules of commerce. I found that much of what he said can also apply to health professionals. As reviewers have commented "Lewis Hyde is not only a beautiful prose stylist but he is a thinker to match, for The Gift offers a challenging and provocative argument about how we value things. He uses wide-ranging examples from across cultures and epochs and leaves you at the end valuing all the more those things that can't have a monetary worth attached to them" and " ... it speaks directly to you about what makes us tick as human beings, what we do for love and what for money". I do deeply feel that anyone going into the health professions primarily because they want to make a good income is an idiot in multiple ways. If you have the brains and drive to be an excellent health professional, you certainly should be able to get a good deal richer through other more commercially-orientated ways of earning a living. It's well worth asking though what actually produces happiness and life satisfaction. Wealth can help but it also creates distance - both for individuals and for society. Multiple studies have shown that putting "high income" near the top of one's job priorities is typically associated with worse outcomes for life satisfaction and wellbeing (Kasser & Ryan 1993; Schmuck, Kasser et al 2000; Niemiec, Ryan et al 2009). And, maybe most importantly, seeing patients as primarily a way of making a good living is likely to reduce one's helpfulness as a health professional as well - it's been known for many years that empathy and caring are central to a patient's satisfaction with both medical and psychological treatment.
But poverty, of course, is a huge problem. Financial hardship and particularly debt contribute to many negative outcomes including depression. It's a balance. As an accountant friend said "You know you're comfortably off if you don't worry when the electricity bill comes through the letterbox". And not having to worry a lot financially means we can focus better on being excellent in our work as health professionals. Too high an income though (I'm talking particularly about doctors here) and we're likely to become cushioned and distant from the reality of many of our patients' lives, and we'll contribute to the suffering engendered by societies with high income differentials. It may seem a bit puritanical in our current culture, but science tends to support Aristotle when he wrote ‘‘(Happiness) belongs more to those who have cultivated their character and mind to the uttermost, and kept acquisition of external goods within moderate limits, than it does to those who have managed to acquire more external goods than they can possibly use, and are lacking goods of the soul ... Any excessive amount of such things must either cause its possessor some injury, or, at any rate, bring him no benefit."